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Savings Likely by Using Generic AIDS Medications, But Will it be as Effective in Treating US Patients?

Using a generic medication for HIV-AIDS could save $1 billion a year, but it may not work as well as the brand-name medications, according to a new study.

A study by Massachusetts General Hospital (MGH), featured in today’s issue of “Annals of Internal Medicine,” quotes the hospital’s Dr. Rochelle Walensky, who also teaches medicine at Harvard.

“The switch from branded to generic antiretrovirals would place us in the uncomfortable position of trading some losses of both quality and quantity of life for a large potential dollar savings,” said Walensky in a statement.

"By estimating the likely magnitude of these offsetting effects now – before generic antiretrovirals actually hit the shelves – we can confront our willingness as clinicians, patients and as a society to make these difficult choices," she added.

The government covered most of the cost in 2011 for antiretroviral medications to treat U.S. patients. It totaled some $9 billion that year.

“The currently recommended treatment for newly diagnosed patients is a single pill (Atripla) taken daily that combines three brand-name antiretrovirals: tenofovir (Viread), emtricitabine (Emtriva) and efavirenz (Sustiva),” according to a report on the new study. “A generic form of the antiretroviral drug lamivudine, which has a similar mechanism of action to emtricitabine, became available in January 2012, and a generic version of efavirenz is expected in the relatively near future.”

Telling patients to take three doses a day rather than one makes it more likely that patients may skip doses. Also, lamivudine may be “slightly less effective and more vulnerable to the development of drug-resistant viral strains than emtricitabine,” the study said, citing lab studies.

Researchers also warn there could be a loss of life expectancy of 4.5 months.

"For patients who take their medications well and adhere to the medical regimen, the generic option will be a bit more complex but could be as effective as the standard regimen,” Walensky added. “But a patient who relies heavily on the simplicity of taking a single pill is more likely to suffer detrimental effects, since missing doses will increase the risk of treatment failure.”

"This is a trade-off that many of us will find emotionally difficult, and perhaps even ethically impossible, to recommend,” she said. “All of us – consumers, providers and advocates – would be far likelier to embrace such a policy change if we knew the savings would be redirected towards other aspects of HIV medicine."

The generic versions of the HIV drugs will reportedly soon reach the U.S. market.

Concerns about putting costs over patients when it comes to AIDS treatments have taken place before. For example, the AIDS Healthcare Foundation criticized Gilead Sciences its CEO John Martin for its “record profits” which were achieved in Q3 2012.

Part of that success financially was due to “AIDS drug price gouging,” the foundation claimed.

"This is about as clear an example of AIDS drug profiteering as one can get. Gilead, under CEO John Martin, scored record profits in the third quarter by gouging hard-hit government programs and private insurers with incredibly high prices that do not reflect the reality of the R&D involved in developing these lifesaving drugs nor the actual costs to manufacture them," Michael Weinstein, president of AIDS Healthcare Foundation, said in a foundation statement.

The news about possible cost savings comes as AIDS has been replaced by overdoses of drugs, such as pain-killers and heroin, as the top cause of death among Boston’s homeless adults, according to a study by Mass General Hospital.